Provider Demographics
NPI:1093414799
Name:BROWN, CHANEKA N
Entity Type:Individual
Prefix:
First Name:CHANEKA
Middle Name:N
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 WOOD CARRIAGE WAY # 1749
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-5016
Mailing Address - Country:US
Mailing Address - Phone:443-410-8454
Mailing Address - Fax:
Practice Address - Street 1:1749 WOOD CARRIAGE WAY
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-5016
Practice Address - Country:US
Practice Address - Phone:443-410-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD372500000X, 372600000X, 3747A0650X, 3747P1801X, 376J00000X, 172A00000X, 376K00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No376K00000XNursing Service Related ProvidersNurse's Aide